This conference begins with a young, otherwise healthy patient with sudden severe abdominal pain, profound leukopenia, lactic acidosis, CT findings concerning for ileocecal inflammation with intussusception, and an emergent operative course complicated by ischemia, temporary abdominal closure, later anastomosis, leukocytosis, diarrhea, C. difficile testing, and eventual concern for an anastomotic leak. Additional cases broaden the discussion to intra-abdominal infection in patients with advanced malignancy, limited surgical options, and uncertain source control.
The teaching portion focuses on how to decide antibiotic duration after source control, when short-course therapy is appropriate, and when persistent leukocytosis or new imaging findings should prompt re-evaluation rather than reflexive antibiotic extension. It reviews STOP-IT-style reasoning, the CABI trial, C. difficile as a competing explanation for post-operative leukocytosis/diarrhea, and the difficult judgment calls that arise when adequate source control may not be achievable.